Surgeon brings less-invasive technique to implanting heart pump to UM

Doug Kapustin, Baltimore Sun

Dr. Si Pham and patient Walter Amprey, chat in an exam room at the University of Maryland Medical Center. "I recognize I'm fortunate to be alive," Amprey said. “God has taken care of me so far -- God and Dr. Pham."

Dr. Si Pham and patient Walter Amprey, chat in an exam room at the University of Maryland Medical Center. "I recognize I'm fortunate to be alive," Amprey said. “God has taken care of me so far -- God and Dr. Pham." (Doug Kapustin, Baltimore Sun)

Jonathan Pitts, The Baltimore Sun

Walter G. Amprey was driving his wife, Andrea, home from a restaurant one night last December when he turned onto an on-ramp for the Baltimore Beltway.

A sudden dizziness overcame him. He blacked out. The family SUV ran off the road and rolled into a tree.

The pair survived, but Amprey had suffered severe heart failure. It would take a team of surgeons at the University of Maryland Medical Center — and a new operating-room technique — to give him his best chance for a full and rapid recovery.

A week before Christmas, Amprey, 69, became the first Marylander to receive a life-extending cardiac pump not by way of breastbone-splitting open-heart surgery, but through a pair of tiny slits in the torso.

The technique was pioneered in Germany just two years ago and brought to the United States last year.

"Open-heart procedures [are] traumatic and are best done [only] when necessary," said Dr. Si Pham, director of the heart and lung transplant center at the hospital and the man who brought the procedure to Maryland. "They bring high risk of infection. They cause scarring in the heart that must later be surgically removed, and they increase recovery time. Minimally invasive surgery is a safer first step."

As recently as 2003, Amprey, a one-time superintendent of Baltimore City schools, might have seemed an unlikely candidate for any form of radical surgery.

At 6 feet 4 inches tall and more than 230 pounds, he had starred as a football lineman and discus hurler in high school. He was a regular at the gym, had an appetite for work that matched his doctoral pedigree, and possessed a congenitally optimistic outlook.

"I was basically accustomed to being able to do whatever I wanted," Amprey said during a recent visit with Pham at the medical center. "Maybe I didn't realize how lucky that was."

He had no idea he also suffered from cardiomyopathy, a deterioration of the muscles around the heart. One day a decade ago, to his shock, it caused heart failure.

It was hard,Amprey said, to accept that he had such a serious health problem, buthe followed the orders of his cardiologists at the University of Maryland Medical Center. He cut fat and sodium from his diet, took a battery of medications and kept an exercise regimen. He even heeded a physician who advised him to have a pacemaker put in, along with an internal defibrillator that could fire life-saving pulses should his heart need the help.

That's what happened Dec. 10 when Amprey blacked out at the wheel. His Lexus left the road, careened down an embankment and came to rest against a tree.

His heart, weaker after years of use, had stopped for 24 seconds, coming back to life only when the defibrillator did its work.

Paramedics rushed him to the hospital, where doctors decided he needed the transplant. But they feared he wouldn't survive long enough for an organ to become available. They chose to install an electronic heart pump — a ventricular assisted device, or VAD — instead as a "bridge to transplant."

Invented in the 1950s, VADs, which are generally affixed to the left ventricle, help the enfeebled heart pump blood through the rest of the body. They were originally the size of automobile carburetors, so big that surgeons had to split the patient's chest wide open to get them in.

The operation alone can be life-threatening, especially when the patient must undergo another open-heart procedure for the transplant itself.

Over the decades, engineers reduced the size of VADs — they're now the size and shape of a hockey puck — but progress on the medical side was slower. It wasn't until 2011 that surgeons in Europe, particularly in Germany, began perfecting less-invasive implantation.

Enter Pham, a native of Vietnam who immigrated to the United States in 1975. He later learned his trade at the University of Pittsburgh Medical Center, a facility known for its innovative organ-transplant programs, under Dr. Thomas Starzl, a pioneer in the field.

During a 14-year stint at the Miami Transplant Institute, Pham grew interested in the way a few surgeons were adapting minimally invasive techniques to his field.

The University of Maryland Heart Center hired him last May. Weeks after that, he was on a plane to Germany, where he watched the pioneers at work.

Their approach was to create a three-inch incision in the left side of the chest, where they implanted the pump, and a second in the upper chest just below the throat, where they placed an outflow graft, a prosthetic tube that carries blood from the pump to the aorta.

The procedure is tricky because it limits visibility and access, said cardiac surgeon Simon Maltais, VAD program director at Vanderbilt University Medical Center.

"You can't see the whole heart; you can only see the apex, so the process is less intuitive," said Maltais, who has performed about 40 of the surgeries.

Pham returned to Baltimore and trained his staff. Weeks later, their first recipient arrived. The University of Maryland center joined eight others in seven states — and one in the nation's capital — in offering the procedure.

Maltais said there are just "a handful" of American surgeons performing it, but that at his hospital it has become the approach of choice for valve and VAD implantations.

Amprey is under no illusion that his own path will be easy. He's still waiting for a heart, and he has been using a cane and a walker to get around. But he can hold the batteries that run his VAD in a satchel he wears with a shoulder strap. That's a far cry from consoles that, until as recently as the 1990s, were the size of refrigerators — so big a patient wore them outside the body (and it could take 10 nurses to help him or her go for a walk).

This VAD can also last eight to 10 years in the unlikely event it's needed that long.

Once Amprey regains more strength, Pham said, he'll actually be able to return to normal activities, working in his study or playing golf. For now, that sounds great to the patient.

"I recognize I'm fortunate to be alive," Amprey said. "God has taken care of me so far – God and Dr. Pham."